Manager, Compliance Risk Adjustment

🕒 October 6

🇺🇸 United States – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

👻 Ghost score 2%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Manage a team responsible for facilitating and leading external audits related to Risk Adjustment processes • Ensure visibility through reporting audit deliverables and associated risks for each audit • Collaborate with business areas to prevent, detect, and correct compliance issues identified in external audits • Serve as point of contact for external audits and correspond with auditors regarding acknowledgements, deliverable timelines, and inquiries • Manage submission of external audit deliverables and respond timely to state and federal regulatory agencies • Quality review external audit deliverables for completeness and accuracy before submission • Communicate with internal and external audit partners to clarify deliverables, requirements, and deadlines • Serve as subject matter expert on external audit processes, policies, and quality improvement initiatives • Socialize identified risks with internal partners and enter Corrective Action Intake • Support Corrective Action Plan development and review before submission to external auditors • Maintain detailed audit documentation, including meeting minutes, action items, identified issues, and risk management plans • Prepare and present reports to stakeholders on risk adjustment audit performance and progress • Support strategy development to improve risk adjustment accuracy and operational efficiency • Provide operational and analytical support to the Risk Adjustment department • Research and recommend best practices for continuous improvement in risk adjustment • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Audit, Compliance, Legal, or related field or equivalent experience required • 5+ years Audit, risk adjustment and/or compliance required • Previous experience in risk adjustment oversight and/or coding planning preferred • Demonstrated understanding of risk adjustment regulatory landscape preferred • Risk Adjustment regulatory audit experience preferred • Medicare experience preferred • Active Coding Credential from AHIMA or AAPC preferred • CPMA, RHIA, RHIT or Risk Adjustment Credential preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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